& emree Amerd tg 18 on*Asse(1)2016 -17 Ader s8da0 veo, moss Sgr geass, sdorittee>-560001. Qavo8: 01-08-2016. MmIgs 2016-178 WOR Bake, meted why Pmcvdg xd AQpghs oyM ded ayohobsid abys/edsot ompraiess ahomewest ear ddoins uri, W¥ew:- 1) AO ees Ao: BB 93 aA 62, B: 06-09-1963. 2) XRFO wees xo: BB 37 AB 78 O: 20-08-1979. 3) Aros wz, soak; BA 26 Bw HS 2016, O: 25-04-2016. -00000000- 2016-178 OTD BFE TYE HePo/sARN wAbURAS/aRTN UAbERACLI soLRobOon meeandg aag germeren au soarodd vohoked war dmyOrriy saxon aecbabs . Baweae, meoinay abay Pedvciy ded AQrads sanohor eaeelomt wgexo’ oRos me wakes each MoMA ed AYDSdAas Sywegsood 2016-17de MOI amMOraesd omamsmn werrivah, dobeand. BaGeoOr OTZAds SadoOs wee qodom, OoRPFTIs aaxor smeadgLds agro xoxo BBeoonod sdohwabmend. err omays axsd, ot weardod svyardg ssheords Sorrsg etereh, Potdecst seateysa. eeerivh, Bae swe sowodalty maenarida, evan Prdivd veeoowod Alo mics xox 2 Heobg varads, waded TOWN wl aa gah shod sdecdi ch vgeod wher sacbacd mk aoywene ve aba, wad lecsidd we SEedan exeriva, a seeort esbtordsl welen, xogedgabe geeoa, ot Beto vedtor Garin Eadeytegpiesocd es shoots mBosbmood sexieond. aaayperid weodd, war aabadnvah, (Novo dain’ Guo Bhs) HedLs Kocbs weirrivah, sdxdAeErbAMd, ate, Hed Bars sodmmocench=ys arrie eer Shaded, anQwasd sons wpm Srecbm, Badd Bax swondsen mite esp ard xOsmudmA st shoot sexeond mre owMoved wos eer sahedady vd swoaysench, aclersdo xOseoo shagocd exe Bosbdsrod gSosendye. be 1 wate = %) B90 (A988) Theos gowdobdon’ mdemnv Ads sexerien wokowenhs show Bactmeiy ato side wale doaSrnd dower sess, earch, mebtat-8 vam wes shod satindia aped add ampere ei Amr sesas, vate xox earodaay, 213 18_SCH(1)/16-176(Def Cirr.)8) 9) &) Hoahrnis oyred’s anohobao(ardcho’ saenow’ weenie” cov sem hos ss Mossg ess AQmogcdssid) Dy /esoconsh dAohawamd MayOr Sesay wars Hodsd. ARWFIS SHes ¥N0: GBI ABL 66 Omo¥8: 28-02-19660q0b Booewow* SOMONY Hyw/edse s OuyPraess adadeo earow. Ug Aeslod syiMod sowed sidoingch gawem, mobudy adap Pmowag wed AQIS AOOobar ajododsd sdy/esoonsd ot DmPFaS aedodw eardy, 2. weterOxbst ome = s) 8) @) E wwe Schedob 38 metr—‘a'(Part-a) grist, GSraRa OOF ads SBS sors Ak BVA AowoPeles, dy eheorent Qaeneg sedtoxedend, Howomaty Cys gees wOmore, aete—'o’ (Part-B) grist, dae BA DES Ayohohad xem crer Asdwa, ow, Gecsoxcdesd. 20m SBrodad, Aeao sBedonod Semon ava SRE, owogate;, WEVA sddorAdowedew. apis'e—‘a'(Part-A) aba) meis'r—‘d’ (Part-B) B3rRaow xtoind sosd Rost wood SwETIva, Food seed Anohobacd aeroraeN HOseOr aeste—'n’ (Part-C) geridia, Bsrain@ mBordmoood Actor mara moZo(BAIB)SQ Torimohagd, edd Adda, Taw ays ansied aedeenarbyss. DPR AowoHados seh Aawabs Taro gid Boba, orga, maria SBS Beoows oop XAPeMY daidaah, vadw0G-209 (2.00 Bs) How st seco ddbateadiew. acy Soy@rnvod warriva, AgBOR Hood node soon’ = SOF HMOs = WaaRNovAD, BEATA. OA HAciRA Oda, vaevr, vars Aeodgd wna ANDS USD ded weds weieTivs, abe Addy, ainadte mew, KURA AmaPeriv/aecwed we ss egeom Recbsios aedackumc. s Bedowons Eats Savard oscse word angnaad wxQobe egw Dmotdadd etterivah, eebtomayed. (gs evads cos, Hbteamoss weirrivah, sonedozes majayson agomodb amgent Tsbeg, Schajeb. noob weagnor 01 dor 30 gaet waierivnh, AQxee mOUMMUDHES. s Omorchevit weerva, owobsich am penvort AEBOL, EAGCTO sedeoreee), 1 OeR@rod ods aairri’ acy Adore vowsyis (ziade sides ReOdod) Boda, svsodos orlgrdziew. 22 18_SCH(1)/16-176(0ef Cir.) *| 1* Year B.E Students =]SSLC and PUC or +2 marks cards {All Copies with attested). 2" Year B.E Students = [1 & 2m Semester marks cards. 34 Year BE Students = [3& 4% Semester marks cards. 4® Year B.E Students = [5 & 6% Semester marks cards. DayOrab odmajcle Kx’ eowstjo Howogaty, axamoodood noded soddrad & AmHrh Xowopacios POmross Dradm, MOWED GRcdrncOr origswac mm POmosd ems aed | AGRAAG ~—wORTCR, — ammod —Oyperdrad.noart ongginadcd. 2. Age ch atin wows eres ge (Kee agodm, otgxeiem) (CET Admission Order). 3. Om~Groh Am~Pr avohdg wvecdsoads mre ews sey axe Weode ucnachs orl Tater wea, ahmed Gedou onan seddordowsied. 4. Sthwog-IdQhsos vseoms gee xy (OmAProw dy dd Pecor wieeds sBecdooiwngds ag) ongxdierd. 3. wetrobsd, meeorivg agsowen she, OoypeTId AQsen sodod Omovseh, 01-10-2016 dos 25-10-2016 davh oom anowdaad. gash wod edeniva, AgpoaeRID. DMPFSES showers sassy ovowsad, sae angwaad todod” omoean, Eepl_N mOxideo, amaQeTIeoD Sey madnesoot gar stead exer, noes HgedObQ BoveDad Howse mBOMEDOG aoseoot s eco Ome: 2016, avi senses vebtoxtied, ANQHAAD Omovd Koss cbs exirriva, mowaed Bosdgohe sd babes. cond sed dah mosdd/eiveaives eBFODaD, debtom Bowbstod negibagd® dh: sekedabad, xozirtxen Sexdaicd. 4, Breese abe Hx she amprom moiieg sdnat gees sds Omordod sgede sai sipNodwsadr, vodd 10 Zonet ang, 1. [SmGros amPrasmaag vim ewe SxS orf dos Dero Bmasncags soriet ~| © 70/se8 7, [DEYPFOS sos sees AIA YAT sorter =F 15/-cos8 3. [Romoabd gg, Sars =| © 100/-s03 [8a 8, Sa =]% S0/ses 23 18 SCH(A)/16-176(0eF Cir.)5. AOFM JeDosdaysacsleoa, Omomde Acersmoobs (1 seseOrl) edtouteddowd 3 Hood Sexennd marke wad waned cinate arte wood slic Aogabsidd Sedan egcoobad, Howes BebSodsh, aeicd doOrrien ads, decaitort arasedond omen vQPWAN aAadsadl. xele cide QoaPerivd sda Heesiecd vekeo Aaodd soxIg (Basirs, 10.00 Potmnocs wxvost, 3.30 HotladsdA) Aadobug Sods aedsmh, wah, SERS Coeswood aaa, Sea sh eeort esbiosda\dah, agroomdedocd aaesad. 6. Am~HFKeh Ards Hrs wersich edesdos OmaGr sesdda, vat Kecdds cnagegs mor'(Nationalised Bank)smgnen Sedan) ant. eags/eosa.ow sosnosd Peomyoried sh swariegord seas wa sadY Aoyprrisd Beodds mays enoe'(Nationalised Bank) amsn¢ xos4(Account Number), 2.07.07. 82ca"(LFS.C code) ae, mosnieg 890 shad sordevt Besa, BOS Dd Seadods DBdsa, Aecitiemarbye. Gt Dade, wsbzfort-9 (Form-9) cadet sneis'e (Mandate Form) 49 Aeddelerenchgc. OBR NoweDATOS INO, veraahad, ar Go Tf uemdoss OmOrob ore AROS wxryow-9 (Form-9) Ayxdux maxX (Mandate Form) Dx vabwornes, & Sater Isom BIA dob. OmBPFab wale Achavobm vAS Wad” sdb» decemdmMahe monmvor Svc hom See ae sdbordeyd wore weirrivn, soyormmam, gag deo Bos mommed Boxesemnage. OMAR, MHODUT vir me Ged NZS MBwInvR VOTOZO abs aNawaLT DRDO HOSS SATE BOTOTS NURRETY weber SoYOMeMMADH. 3 woreteren OagPereh Dm Arata ZI400, gonsscto CoM AI. http: dte.kar.nic.in co iy adie de enon a oe, We 1. @psREd, avy aero, embeds ada aman wadcnd dis KowDoboont meeearit (orb 33 aterm Poder) aad aay. 2. AteFYmOhS Ram Fors, 3. &8OFL., S088 Sgro AdersmOad, done. [AC Hockarsmpmdabsts, a-udes, s03% Bete Adersmedd, vorttod. 5. BeQglo wa (was¥). 4. 18_SCH(1)/16-176{Def Cir.)GOVERNMENT OF KARNATAKA davrué xeerd Department of Technical Education 32033 8329 qe033 19638e wd AxpwO Ge Omodd UB 93 oan’ 628 Fmoks APO EHD monet aad Gareaiod ahedit APE sirirciais abxot / wagon cadosnss Byeo DaimeNs wale FORM OF APPLICATION FOR THE GRANT OF EDUCATIONAL CONCESSIONS TO THE CHILDREN/DEPENDANTS OF SERVICE PERSONNEL UNDER THE SCHEME SANCTIONED IN GOVERNMENT ORDER NO: ED 93 SCL 62, DATED THE 6™ SEPTEMBER 1963 PART - “A” Barcen/sacésre FRESH/RENEWAL CY Care Bae “| (@)__ Name ofthe Applicant - welrtedonte Ad siircisorte achat towod TDS / BY / SH WY / GH wg / Anewd / Roedd / wi, (SercRUUsy, TEI ce | SAcAROAEY, sh woud, saison Sele) Relationship of the applicant to Service Personnel-Son/Daughter / Adopted son/ (b) Adopted daughter/ Brother /Sister / Wife (in. | - case the applicant is adopted to some other person, It may be clearly stated). (a) Boyprad soba =| (© Age ofthe Scholar : (&) eetreRdd as OVO | ©) (@)__ Residential Address of the Applicant - 2 Mobile Number puudent z FF SRST _ Particulars of the Service Personnel:- . (©) Ba : (a) Name 1 (8) 8ed088, woragoon emia age : (b) Whether alive, disabled or deceased - Gr ckaensad Se DodAIY AOASIOS Aeon ( gaypr Nonogalty ator eigsia, dacancode |- Whether a certificate regarding service etc, as © required by Rule 2 pfthe scheme is enclosed. (&) mobo awA . (Permanent Address - (w) sind owe - (e) Present Address - (eo) wvthagn seslogmengs. : (© Occupation, ifalive - etrcedon Romo (eFERCAD ce sy / de (ab) abgainngs eam, 6 dey Sreddsoamagcd |. Sounddah, AOFHISRN sexed), Relationship to the Applicant (in case of (g) adopted children, it should be specifically stated whether he has adopted the Ap,a Local Guardian’s particulars:- dee (a) Name (wage (0) Occupation (2) eeredonestod xonor (© Relationship to the applicant (oven (@) Address Se SE FRY SSPE BT ST soa Sorts fa _ Isitution and the Clas in which the puplis studying during the current year. (©) bons Bir DERBe maxon Boxtey sors Class in which he was studying during the 0) . previous year. sq) DEROFOHD SBSOOS Suna Seriecd aides? @ og ede sereadg weds? fq, Whether he is promotee or detained inthe same class (3) ete Snr agdasmeNS aart acbyO ce? ‘ay Ifdetained in the same class, reason for © detention. (ey) WOOH SH HED oh chores abeC edd oh Doses ede) Sai sie goer Year and the class in which he was getting the (© concession under the scheme during previous years. Oe SEES SET BS SETEE ss gskmre widsid, cog, acasedew) Name of the Hostel in which he is residing (@) (certificate from the Warden should be attached). anyrosd mamengOgs, aesidads (©) sateenmdobe egw dedatyacss SRAEDAEAAGDE Oo eowEIAd, Sexe Ifnot residing in the Hostel, whether residing (6) _ with parent or any other person should be indicated. RightC wpm cheese ceo Signature of the Parent or Guardian Signature of the ApplicantPART -"B" CERTIFICATE OF THE DEFENCE AUTHORITY Certified that No. Rank.. Unit. Father/Brother/Sister Husband /Daughter/Son of School/College is a Commissioned or Non-Commissioned Officer/Junior Commissioned Officer/Other Rank/Combatant (enrolled) in the Army/Navy /Air force and is serving with this Unit /is Killed / is permanently disable. Rank, notin receipt of any educational allowance for the Government of India, Certified that No... Unit « Station: Signature of the Officer Commanding or the Date: Competent Military Authority and the Seal of Office. Forwarded to the Head of Institution, for verification and re- commendation to the Sanctioning Authority. A duplicate copy of certificate (Part-B) is sent directly tothe Sanctioning Officer (Director of Technical Education, Bangalore). Signature of the Officer Commanding or the Competent Military Authority and the Seal of the Office. Haws (I) dmpedial, eOROY ad¥erke wBZOrLe 262-1966 Oot GA 3 ABL 66Se SEBOET ARO ZNO Bevcdaiod st loensdod sheot oosmans sidohen wey, ‘The Children and dependents of Commissioned Officers are not entitled to the concession under the scheme in accordance with Government letter No. ED 3 CDP 63, Dated 26-2- 1966. (i) cSoeesdad shedit oosmetDsries 11/20-I1~65ae Bmows TA 40 NBL OSae YanOET AIFOE HgdQ Srechaiod ( Oxmdivood aaa. daypleat aed Rees Good) awn odQ arabe Boondaad ayer abe esr dadomAog, ‘The concession under the scheme are not admissible to the children and dependents of the persons in the N.C.C. (except persons on deputation in N.C. for the Defense) in accordance with Government letter No. ED 40 CDP 65, dated 11/20-11-65, (i) SmRFam og engRAS eae weod, Anecid, Roedoohd easeocd GusmeOAelenece, Ueee CLIQUE COM UES AacciBON Oot: 16-10-19653e Qm08S BB 21 ABA 64S EaDOET AmOFO UceTgMOG sAckRUTrO sheod aye wiwon Aomebs chews ato bwAsAdord ¥ AmAwrob YoroiwrO eye xonogTy, anon aad aagceno cheosma Haxelet, ge To establish ‘Dependence’ on a member of the defense services wife, brothers and sisters, the father of the student concerned or other head of the family concerned should prove that the member of the defense services was remitting money by money order or by family allotment for the maintenance of such dependent in accordance with Government Order No. BD 21 CDP 64, dated 16-10-1965. 2 29 daeddred extrie Aomodann Bt eefedod choneues etiead samo sbey Omotrived, sd cepa! meriig Xow korciedee, ‘© (Here the information in the blank should invariably be furnished in respect, of renewal cases with the number and date of this office sanction order). 3PART Amyoieh shumpmdad dane, RECOMMENDATION OF THE HEAD OF THIS INSTITUTION wetrobg satiphst stobeeridsh, mid Aecdr Ancaddorin Ha, suhaledad abiyt ech doatandabodto mea gaker staged, watrcaddsh ch clacesdad sbedt oatmons xddaingy / xdadog / sds, oda_ BHEAY ch doinos Shedding sogmMOGYE. Certified that I have verified the information given in the application and the same is correct to the best of my knowledge. * The applicant is / was not in receipt of the concessions under the scheme and he is eligible for the renewal of concessions during the year 2016-17 waroROaN & aw0Os CotmeDENY Setdey mgRNERS. BRIM amageS / SID SmMBOy- Trecommend / do not recommend the case for award of the following concession:- (1) Ses day (yZs Ostertvad, Sevan Rawsredee) Free Student ship (Details of fees should be indicated separtely). (2) Soest Keen (Gees abe Se Gg) sortert do Maintenance grant (Boarding and Lodging allowance) of Rs. (3) D¥srert wee koa oe Book grant of Rs.. (4) DeneTen ae bi Clothing Grant of Rs. Semplofed swempmdad chen Signature of the Head of the Institution DEPENDENCY CERTIFICATE As required vide G.0. No.: ED 21 CDP 64, dated 16 October 1965 Certified that the case of Sri... studying in No. brother/sister of Sri » Serving in has been verified in the light of G.0, No.: ED 21 CDP 64, dated 16% October 1965 and found that he is wholly depending of the Service Personnel. HEAD OF THE INSTITUTION Note: This Certificate has be issued on the strength of proof produced by the candidate or the head of the family for having received the money orders on family allotment by the Service Personnel. ~Aemvog-1 exvong az, xosdy 9B 21 ABS 64 Qev0¥: 16/10/1965003 Se: S¢m3------------------------------------------------- PWECVSY LYdAHo oyrso Gedg----—------------------------ odmaes'ag----—---------—---------—1 ON 9» OSB pm nnn obghaad xABecdd / ABMGORAM, SAH Homer eHoomsooiays aoc shes Seed Aworo SBeId Gd DOSeOa DHevoad. wsee awdeo * Reed oe & qahere ayaa, Om—Hr watd wenowdision dyn civdsiood ao Agsoabaieg ab eIFO Regt Dead GUS shed aatwrdeson Bpedorddetd, -5- 18_SCH(1)/16-176{DeF Cir.)se exsuog - 9 Form -9 Government of Karnataka Finance Department Department of Treasuries Electronic Clearing Service (Credit Clearing) Real Time Gross Settlement RTGS) National Electronic Fund Transfer (NEFT) facility for receiving payments. MANDATE FORM ‘A. Details of Accounts Holders (Student):- T First Name: Name of the Recipient (Student) Second Name: Last Name: Institution/ College Course & Is, 204, 31 & 40 year Recipient type (Category) USN/Reg Number for 21, 3% & 4 year SSLC / PUC Reg No for 1* year ‘Aadhaar Number Voter ID Complete Institution/College Address | Address 1 ‘Address 1 Pincode Mobile Number of the Recipient Student Parents E-mail (e-mail of the recipient) Fax Number (of the Inst/College Office) aB, Bank Account Details of the recipient:- Bank Name Branch Name Type of Bank Account (Please Select | Savings [] / Current Account [] the type of Bank Account) *Minor EI / Major CI Account Number (as appearing in the cheque/Pass book) | 9 digit MLCR Code of Bank Branch | LE.S.C Code of the Bank Documents Enclosed Photocopy of the Cheque Leaf issued by bank Photo copy of the Amount Recent Transaction(amount deposited/with draw Zerox of first page of pass book bearing Account Number ¥ The Student having a Minor Account in the bank cannot be accepted to NEFT process. * Without Bank transaction cannot be accepted to NEFT process. Date of Effect :- Thereby declare that the particulars given above are correct and complete. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information I would not hold the Institution responsible, I have read the option invitation letter and agree to discharge responsibility expected of me as a participant under the Scheme. Date: Signature of Student Should be Verified By Case Worker Date: Signature of Case worker Date: Principal Signature & SealForm 9 Government of Karnataka Finance Department Department of Treasuries MANDATE FORM, Flectronic Clearing Service (Credit Clearing)/ Real Time Gross Settlement RTGS)/ National Electronic Fund Transfer (NEF1) facility for receiving payments. ‘A. Details of Accounts Holders (College Principal):- ‘Name of the Recipient (Principal) First Name: Second Name: Last Name: Institution/ College Office Recipient type (Designation) ‘Aadhaar Number (Principal) Voter ID (Principal) PAN Number (Principal) Provident Fund Number (Principal) ‘Complete Institution/College office Address | Address 1 Address 1 Pin code Mobile Number of the Recipient Self Office & Residency E-mail (e-mail of the recipient) Fax Number(of the Inst/College Office) Remarks IF Any LB._College Bank Account Details of the recipient:- Bank Name Branch Name Type of Bank Account (Please Select the type of Bank Account) Savings Current Account Account Number (as appearing in the cheque/Pass book) 9 digit MICR Code of Bank Branch IFSC Code of the Bank Document Enclosed Photocopy of the Cheque Leaf issued by bank Photo copy of the Transaction(amount deposited/with draw Zerox of frst page of pass book bearing Account Number * Without Bank transaction can’t be accepted to NEFT process. Date of effect:- Thereby declare that the particulars given above are correct and complete. If the Transaction is delayed or not effected at all for reasons of incomplete or incorrect information I would not hold the Institution responsible. I have read the option invitation letter and agree to discharge responsibility expected of me as a participant under the Scheme. Date: Seal & Signature of Principalnowgremearc cnectS gage pacha suze gee oe ahomox qoaestear ace AUCUOE See poset Robenece wee prononon view que face mene yaucsuoe ea eace@ *raRcneoesuers quseec eo ecco a gonvoomox Was eum Tacs cies eRe poelte | (x | yauoe ‘ones & % a 2 Spe exe | on be ome jee bone fore | gome | fore | eee . an enna eupe | derwe|'or | be | [AE | be | ee | he] be | Se [ectes| SE = wouoe or) | Seqz | exmaee | oe east | mie | qoute | teror vas | yosteee qosgtae en te [prea sie gocexpes | uoH! = goeeg Steow eopStee - pm pepe 7 — Rona